title: Migraine management in community pharmacies: practice patterns and knowledge of pharmacy personnel in Thailand.
abstract: OBJECTIVE
  To describe practice behavior and understanding among pharmacy personnel, both pharmacists and non-pharmacist staff, in the management of mild and moderate migraines.
  
  
  BACKGROUND
  Migraine is recognized as a prevalent and chronic neurological disorder. In developing countries, such as Thailand, community pharmacies are a widely used source of health care for various illnesses including migraine. However, the quality of migraine management and knowledge among pharmacy personnel is unclear.
  
  
  METHODS
  Cross-sectional study. The sample comprised 142 randomly selected community pharmacies in a city in the south of Thailand. Simulated clients visited the pharmacies twice, at least 1 month apart, to ask for the treatment of mild and moderate migraines. After the encounters, question asking, drug dispensing, and advice giving by pharmacy staff were recorded. Subsequently, the providers in 135 pharmacies participated in the interview to evaluate their knowledge in migraine management.
  
  
  RESULTS
  The majority of pharmacy personnel were less likely to ask questions in cases of mild migraine when compared with moderate attack (mean score [full score = 12] 1.8 ± 1.6 vs 2.6 ± 1.5, respectively, P < 0.001). Mean difference of question asking between mild and moderate migraines was -0.8 (95% confidence interval -1.1 to -0.5, P < 0.001). Approximately 33% and 54% of the providers appropriately dispensed non-steroidal anti-inflammatory drugs for mild attack and ergotamine for moderate migraine, respectively, P < 0.001. Prophylactic medications (eg, atenolol, propranolol, flunarizine) were inappropriately recommended, particularly in moderate attack (28.2% vs 17.6% in mild migraine, P = 0.018). Less than 30% of providers advised the patients on the maximum limit of dose or discontinuity of medications when recovered. Compared with non-pharmacists, pharmacists tended to ask more questions, give more advice, and dispense less appropriately; however, there were no significant differences. The results from the interview showed that most pharmacy personnel had inadequate knowledge on migraine management. Pharmacists had better knowledge on question asking (mild migraine 5.1 ± 2.1 vs 3.1 ± 1.3, respectively, P < .001; moderate disorder 6.5 ± 3.1 vs 3.9 ± 2.1, respectively, P < .001) and tended to have more knowledge on advice giving but poorer drug dispensing in moderate migraine according to the guidelines, relative to non-pharmacists (20.5% vs 40.3%, P = .014).
  
  
  CONCLUSIONS
  A large number of community pharmacists and non-pharmacist staff had inappropriate practice behavior and understanding. Continuing education and interventions are important to improve the practice and knowledge of pharmacy personnel, particularly the pharmacists.
authors.affiliation: Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Woranuch
authors.initials: W
authors.lastname: Saengcharoen
authors.forename: Sanguan
authors.initials: S
authors.lastname: Lerkiatbundit
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003157:Community Pharmacy Services / Q000592:standards*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D010595:Pharmacists / Q000592:standards*; D010596:Pharmacy Technicians / Q000592:standards*; D013339:Students, Pharmacy; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
keywords: Thailand; knowledge; management; migraine; pharmacy; practice